Universal medical system

ABSTRACT

A system for operating third party proprietary software on a medical monitoring device operating native proprietary software and a system for obtaining compatible third party proprietary software for operation on the monitoring device.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is a divisional of U.S. patent application Ser.No. 14/067,728, filed Oct. 30, 2013, entitled “Universal MedicalSystem,” which claims priority benefit under 35 U.S.C. §119(e) to U.S.Provisional Application Ser. No. 61/720,302, filed Oct. 30, 2012,entitled “Universal Medical Communication System,” the entirety of whichis incorporated by reference herein.

The present application is also related to and incorporates by referencethe subject matter disclosed in U.S. patent application Ser. No.13/651,167, entitled Medical Monitoring Hub, filed Oct. 12, 2012 andU.S. patent application Ser. No. 12/723,526, entitled Open ArchitectureMedical Communication System, filed Mar. 12, 2012.

FIELD OF THE DISCLOSURE

The present disclosure provides communications and display informationfor patient care equipment. In certain embodiments, the disclosurerelates to providing an open architecture and cross platformcommunication, processing and display system.

BACKGROUND

Hospitals, nursing homes, and other patient care facilities typicallyinclude patient monitoring devices and other patient care equipment atone or more bedsides in the facility. Patient monitoring devices, forexample, generally include sensors, processing equipment, and displaysfor obtaining and analyzing a medical patient's physiologicalparameters. Physiological parameters include, for example, respiratoryrate, blood gas levels, pulse, ECG, EEG, glucose and blood pressure,among others. Clinicians, including doctors, nurses, and certain othermedical personnel use the physiological parameters obtained from themedical patient to diagnose illnesses and to prescribe treatments.Clinicians also use the physiological parameters to monitor a patientduring various clinical situations to determine whether to increase thelevel of medical care given to the patient. Some patient care devicesinclude proprietary software with proprietary indications that can onlybe used with their devices. Thus, often, multiple different redundantmonitors may be required based on which software or indications aphysician requires. Other patient care equipment can also used to assistin the care of the patient including medicine dispensing equipment,communication equipment, alarm signals and other devices.

Patient monitoring devices must be highly robust and able to toleratecomponent and device failures. Robustness is of particular importancewhere devices are used to monitor patient status in health carefacilities. For example, if a component of a monitor fails, such as analarm, the alarm conditions may go unnoticed. In some situations, if apatient monitoring device experiences a failure during operation, thefailure may necessitate disabling the entire device.

SUMMARY

An aspect of the disclosure includes the ability for a patient caredevice to display proprietary third party parameters and displayedinformation or display configurations in a safe and effective manner.For example, a care provider may prefer the accuracy of one patient caredevice with the display layout or derived parameter information ofanother system. A care provider can select on a patient care device theoption to use third party proprietary displays and derived parameters.In an embodiment, the third party parameter can be selected andimplemented based on a single use or use per patient. In otherembodiments, the third party parameter can be selected and associatedwith a particular device.

Other aspects and embodiments of the disclosure are disclosed throughoutthis specification and in the drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A and 1B illustrate embodiments of a patient care system using avirtual machine.

FIGS. 1C and 2 illustrate examples of patient care networks.

FIG. 3 illustrates a typical pulse oximeter with display screen.

FIG. 4 illustrates an embodiment of a software application downloadscreen.

DETAILED DESCRIPTION

Various embodiments according to the disclosure will be describedhereinafter with reference to the accompanying drawings. Theseembodiments are illustrated and described by example only, and are notintended to limit the scope of the disclosure.

Medical monitoring devices often include software for providingproprietary parameters or display configurations. For example, somemedical monitoring devices include a proprietary wellness indication orproprietary parameters that are exclusive to a particular medicalmonitoring device. Medical professionals often have preferencesregarding medical monitoring devices. For example, some medicalprofessionals may prefer the accuracy of a particular medical monitoringdevice, but the display layout or proprietary parameters of othermonitoring device. Due to the proprietary nature of this software,medical professionals are often required to make compromising choicesbetween medical devices. In some cases, medical professionals useredundant devices.

The present disclosure provides solutions to this problem by providing asystem to allow third party proprietary software to operate on anymedical monitoring device. This allows a medical professional to pickand choose a monitoring device based on core functionality withoutcompromising on desired third party proprietary parameters or displayand alarm settings.

FIG. 1 illustrates a patient monitor 10 connected to a sensor 5 forreceiving signals indicative of a physiological condition of a patient.The monitor can include a processor running software configured toprocess and/or analyze the signal to determine the physiologicalcondition of the patient. The monitor can be running an operating systemor other software configured to manage the processing of the signal onthe monitor 5 processor. In one embodiment, the sensor 5 comprises alight emitter that emits light of one or more particular wavelengths, oroptionally additional emitters for different wavelengths, and one ormore optical sensors that detect the light emitted from the emitter oremitters, where the emitted light are reflected by, transflectedthrough, and/or transmitted through tissue of a patient, such as theskin of the patient. The sensor 5 may be configured to transmit rawmeasurement data to the processor. The sensor 5 and/or the processor maybe further configured to perform transformations, analyses, and/orcalculations on the transmitted data. This type of sensor is known inthe art of pulse oximetry devices and other patient monitor devices, andits implementation is well known to those of ordinary skill in thosearts. The sensor may also be an ECG sensor, acoustic sensor, hemoglobinsensor, or other type of physiological sensor. It is contemplated that,in some embodiments, different types of sensors and/or multiple sensorsof the same type will be usable within a system.

The monitor 10 includes a third party proprietary software module 12running on monitor 10. The third party software can run on a dedicatedand separate processor to prevent disruption of the primary processorfunctionality, or it can operate on the same processor as otherphysiological parameter processing native to monitor 10. The third partyproprietary software can also simply be an add-on to the existing devicesoftware. In an embodiment, the third party software is simply front endsoftware, used to configure the display and possibly calculate higherlevel measurements, whereas the native software operates the backend andlow level operational and processing features of a monitoring device.

In an embodiment, patient monitors such as those shown in FIG. 1A caninclude a virtual machine. The virtual machine 12 can include hardwareand/or software. For example it could include one or more softwaremodules running on the monitor's 5 hardware. In an embodiment, thevirtual machine and monitor software operate in conjunction with ahypervisor. In an embodiment, the virtual machine runs on the monitor's5 operating system or a combination of an operating system andhypervisor. Alternatively, the functions described in the presentapplication with respect to a virtual machine can operate on the systemsmain software platform. For example, in some embodiments, the virtualmachine can be an application running on the patient monitor or otherpatient care device that runs in conjunction with other software runningon the patient care device.

In an embodiment, the virtual machine is configured to abstract out andtranslate measurements, instructions, alarms, management services andother communications into an open architecture specification which iscompatible with the third party software 12. This allows softwaredesigned to operate on different software platforms to receiveinformation from and communicate efficiently and accurately with thenative software on the monitoring device.

For example, in an embodiment, various aspects of the sensor(s) 5, suchas, for example, raw data, a sensor measurement, a sensor off alert, anexpiration alert, an on/off signal, or the like, is abstracted into astandard format for communication with the third party proprietarysoftware. Various other aspects of the devices can also be abstracted asdescribed in greater detail below.

In an embodiment, the virtual machine is software which emulates theoperating system of another device. In an embodiment, the virtualmachine can run proprietary software intended to be run on a differentproprietary system. For example, in an embodiment, software meant to runon pulse oximeter A will run in the virtual machine on pulse oximeter B.In an embodiment, the virtual machine can run a portion or aspect of thesoftware and is not required to run the entire software. This allows acare provider to pick and choose which portions of each pulse oximetersoftware to use in a setting without actually using two differentdevices.

Virtual machines can be adapted to each individual device.Alternatively, one or more virtual machines can be running on a separatedevice or network location in communication with each patient monitor orpatient care device. Thus, also displayed on a selected monitoringdevice, the third party software can be run remotely from the monitoringdevice.

In an embodiment, the third party software can be in the form of adown-loadable application designed to operate with the native operatingsystem of the monitoring device, or in conjunction with the virtualmachine. For example, various proprietary software packages are capableof determining an indication of the wellness of a patient based onsimilar measured parameters. By way of example, Masimo Corporation ofIrvine, Calif. has developed software referred to as HALO™ whichdetermines a wellness indication of a patient. Other companies havedeveloped competing software packages. In an embodiment, a care givercan choose to run a third party proprietary software application on themonitoring device. In this way, each different care provider can use thesame hardware device to pick and choose which software to run. In anembodiment, the application is run on only a portion of the screen sothat the rest of the screen is unobstructed and displays the softwarenative to the patient care device. Alternatively a second, third,fourth, etc. application can also be displayed and run simultaneously.In this way, a care provider can use the hardware device and processingdeveloped by one company, but can choose the display and informationconfiguration of another company based on the care giver's preferences.

In an embodiment, a care provider can be charged for the hardwareseparate from the software. For example, a hospital may purchase thehardware separate from the software. In an embodiment, the software canbe purchased on a per use or per patient basis. In this way, a hospitalwill not be charged significant upfront costs for various differentsoftware packages that are desired by individual care givers. Thedecision to use or purchase third party software can be implemented in ahome screen on the patient care device. The home screen can provide theuser with the option of which preinstalled software the care giverwishes to use as well as the associated pricing. In an embodiment, thepatient care device can link to a virtual store (such as the virtualstore shown in FIG. 4) accessible via a network 15, such as the Internetor a private hospital network that will allow the care giver to purchaseand download desired software onto the device. Alternatively, thirdparty software and applications can be loaded via a portable memorydevice.

FIG. 1B illustrates a sensor 5 and monitor 10 which communicate with aseparate device 11 including the third party software 12 and optionallya virtual machine. Monitor 10 and device 11 communicate through any typeof communication methods included on the monitor 10, such as, forexample, serial communications, wired or wireless Ethernet, or the like.The third party software communicates with the monitor 10.Alternatively, the monitor 10 emulates the display screen according tothe third party software instructions.

In an embodiment that uses a virtual machine, the virtual machine canabstract out device specific information and format the information intoa form usable by the third party software. For example, the virtualmachine can abstract out the following categories of information: coremonitoring services, special services, low level services and contentmanagement services. Although described in relation to certaincategories, a person of skill in the art will understand from thedisclosure herein that other or different categories or category namescan be used and the present description is meant by way of example andnot limitation.

In some embodiment, certain categories of information are not accessibleby the third party software in order to protect functionalities thatcould disrupt patient monitoring. For example, in an embodiment, lowlevel services and some core monitoring services are not accessible toor capable of being manipulated by the third party software. Rather, thethird party software can be limited to receiving information necessaryto its functionality and outputting to the monitoring device informationfor display.

The core monitoring services can include, for example, sensormanagement, measurement engine management, device management,connectivity management and alarm engine. The sensor management includesservices related to sensor channels, channel errors (such as, forexample, sensor off, sensor expired, calibration information or thelike) and channel exceptions. The measurement engine management includesservices related to measurement raw type, measurement limits, alarmlevels, alarm priority, numerics including waveforms and measurementnumbers, multiple channel i/o, sampling interval, display attributes,multiple levels of alarm thresholds, averaging, 3D alarms, or the like.The device management services include services related to systemfaults, configurations and settings, accounting, performance, andsecurity (such as, for example, authentication, integrity, privacy andthe like). The connectivity management provides services related tointerface connections and the alarm engine manages activation and statusof alarms.

The special services include location and presence sensing, connectivitymanagement for other local device, such as, for example, bedsideintegration, integration with body worn devices or sensors, cameras,speakers, video displays, etc. Special services also include power andhosting services and display access services.

The low level services include time services, which, for example,provide a fine grain time and clock sync service. Other low levelservices include name services and spaces including directories, rules,roles, privileges and scope. The low level services also include a logservice. Low level services can include services which are partitionedwith higher security levels and limited access rights to preventtampering or accidental disruptions. For example, the partitions caninclude protected measurement namespaces that prevent or attempt toprevent one monitoring module from influencing another (e.g., even whenboth modules use the same naming conventions). Namespaces may bepredefined and/or may be generated dynamically. In response to a newmeasurement module being provided, for instance, a new namespace may begenerated for that measurement module. Namespaces can be automaticallygenerated even when modules from different manufacturers are provided.

Content management services include services related to pushing andpulling externally originating content. This can include, such as, forexample, messages (text, voice, data, video) both in and out. Thisallows, for example, advertisements to be displayed or played on amonitoring device. This also allows for direct communications between acare giver at a care center and a patient at a remote (e.g. home)location. For example, a care giver can recommend a treatment to apatient which is displayed on the patient monitor in the patient's home.

In one embodiment, the sensing functions of the monitoring device 110are decoupled from post-processing functions of the device, so thatpost-processing functions can be relocated to the third party software.In an embodiment, this relocation feature can be implemented inconjunction with the virtual machine features and emulation featuresdescribed elsewhere in this specification, and the relocation featurecan be implemented using the virtual machine, emulation or anapplication.

Sensing functions can include receiving data from sensors 102 and/orbasic computations or transformations using that received data.Post-processing functions can include computing waveforms using sensordata, calculating averages or other statistics, displaying informationabout the data on a visual or other display, producing alerts orwarnings on the device, or broadcasting data to data monitors such aspagers. Other sensing and post-processing functions are describedthroughout this specification.

FIG. 1C illustrates an embodiment of a physiological monitoring system100 including an broader device networking system. This architecture, invarious implementations, is a shared, or open, network which includesmultiple patient monitoring devices 110, a network bus 120 (e.g., anEthernet backbone), and a hospital WLAN 126. In addition, the sharednetwork may further include a connection 122 to the Internet 150 orother networks, to end user devices 152 over the Internet 150, and toend user devices 152 over the hospital WLAN 126. The physiologicalmonitoring system 100 of certain embodiments is therefore an enterprisesystem that achieves a cost-effective replacement for currentlyavailable patient monitoring systems.

The physiological monitoring system 100 includes a plurality of bedsidedevices, e.g., patient monitoring devices 110 and/or patient careequipment 111. The patient monitoring devices 110 of various embodimentsinclude sensors 102, one or more sensor processing modules 104, and acommunications module, e.g., network interface module 106. In anembodiment, the network interface module can be built into or form partof the patient monitoring device 110 or patient care equipment 111. Inan embodiment, the network interface module is a separate or stand alonepiece of hardware which can be configured to communicate with one ormore patient monitoring devices 110 or patient care equipment 111. Inthe depicted embodiment, a patient monitoring devices 110 and patientcare equipment 111 are shown. One patient monitoring device includessensor 102, sensor processing module 104, and network interface module106. The other patient monitoring device 110 includes two (or more)sensors 102. A person of skill in the art will understand from thepresent disclosure that any number or combination of sensors, sensorprocessing modules, or patent care equipment can be used with thepresently disclosed system.

In certain embodiments, each patient monitoring device 110 or otherpatient care equipment are used by one medical patient. The patientmonitoring devices 110 and patient care equipment 111 form a network ofpatient care devices, each of which can communicate with clinicians andother end users over a shared network, including a hospital network 126and network interfaces to the Internet 150. The network may use standardcommunications protocols, such as Ethernet, TCP/IP, 802.11b/g/n,IPX/SPX, Appletalk, PPP, and other protocols known to those skilled inthe art. As will be understood by a person of skill in the art from thepresent disclosure, a single piece of patient care equipment or patientmonitoring device can also be used by multiple patients or switchedbetween patients.

One or more sensors 102 of the patient monitoring device 110 areattached to a medical patient. These sensors 102 may include ECGsensors, acoustic sensors, pulse oximeters, and other types of sensors.The sensors 102 obtain physiological information from a medical patientand transmit this information to the sensor processing module 104through cables 103 or through a wireless connection (not shown). Incertain embodiments, the physiological information includes one or morephysiological parameters or values and waveforms corresponding to thephysiological parameters.

The sensor processing module 104 receives physiological information fromthe sensors 102. The sensor processing module 104 of certain embodimentsincludes a circuit having a processor, input ports for receiving thephysiological information, software for processing the physiologicalinformation in the processor, an optional display, and optionally aninput device (e.g., a keyboard). In addition, the sensor processingmodule 104 contains one or more output ports, such as serial ports. Forexample, an RS232, RS423, or autobaud RS232 (serial interface standard)port or a universal serial bus (USB) port may be included in the sensorprocessing module 104. Patient care equipment 111 can likewise includeinput and output interfaces for receiving and transmittingcommunications and instructions.

In certain embodiments, the sensor processing module 104 generateswaveforms from signals received from the sensors 102. The sensorprocessing module 104 may also analyze single or multiparameter trendsto provide early warning alerts to clinicians prior to an alarm event.In addition, the sensor processing module 104 in certain embodimentsgenerates alarms, otherwise known as faults, failures, or alerts, inresponse to physiological parameters exceeding certain safe thresholds.

Example alerts include no communication with pulse oximeter, alarmsilenced on pulse oximeter, instrument low battery (pulse oximeter), andtransmitter low battery. Example alarms include SpO₂ levels and alarms,high and low SpO₂, high and low PR, HbCO level and alarms, HbMET leveland alarms, pulse rate and alarms, no sensor, sensor off patient, sensorerror, low perfusion index, low signal quality, HbCO, HbMET, PI trendalarm, and desat index alarm.

The network interface module 106 in the depicted embodiment is connectedto one or more sensor processing modules 104 or patient care equipment111 through one or more connectors 108, which may be serial connectorscorresponding to the serial ports in the sensor processing modules 104.Alternatively, the connectors 108 may be any hard wired or wirelesscommunications types including wired or wireless Ethernet, telephonelines, Wi-Fi, etc. Dashed lines on the connector 108 indicate that thenetwork interface module 106 of certain embodiments is not permanentlyattached to the sensor processing modules 104. In alternativeembodiments (not shown), however, the network interface module 106 iscontained within a sensor processing module 104 or patient careequipment 111.

The network interface module 106 in various implementations includes aprocessor, an input port (such as a standard RS232 serial port, Ethernetport, wireless transceiver, etc.), a network output port such as anEthernet port, Ethernet transceiver serial interface, etc., and softwarewhich enables the network interface module 106 to act as anetwork-communications enabled device. In addition, the networkinterface module 106 includes a storage device 114, which may beincluded within the network interface module 106 or attached separatelyto the network interface module 106.

The network interface module 106 manages the connectivity overhead forinitiating and maintaining connectivity with end user devices over theshared network. In certain embodiments, the network interface module 106manages connectivity by acting as a microserver or web server. In suchinstances, the network interface module 106 is a network connectionenabled device. As a web server, the network interface module 106establishes direct connections to the Internet 150, such that an enduser may access web pages or third party software stored on the storagedevice 105 of the network interface module 106 or access the Internetthrough the network interface module 106. In an embodiment, the networkinterface module 106 therefore does not require a separate server forconnecting to the Internet 150. In one embodiment, the network interfacemodule 106 connects to the Internet 150 directly through a modem, suchthat the connection 122 includes a modem. In managing connectivity overthe shared network, the network interface module 106 may also performsecurity management functions, such as user authentication.

In certain embodiments, the network interface module 106 sends data overthe shared network through an access point 124 or other wireless orwired transmitter. Alternatively, the network interface module 106 maycommunicate directly with end users over the Internet 150. End userssuch as clinicians carrying notifier devices, e.g., end user devices128, 152 connected to the hospital WLAN 126 may receive real-timeviewing of physiological patient parameters and waveforms on demand orin the event of an alarm or alert. End users can also provideinstructions or other communications to the patient monitor 110 orpatient care equipment 111 using the same end user devices. Real-time orslightly delayed transmission of physiological information in certainembodiments comports with standards for alarm latency in compliance withJoint Commission on Accreditation of Healthcare Organizations (JCAHO)standards for effective alarm response. The network interface module 106of certain embodiments therefore adds functionality equivalent to acentral nurses' station. These communications between network componentscan include information generated by third party software running on theindividual monitoring devices.

In certain embodiments, the network interface module 106 performscontext management. In one embodiment, context management includesassociating context information with physiological information to form acontextual data package. Context information may include severalcategories of information, including the categories of contextinformation related to the network interface module 106, contextinformation related to the medical patient, context information relatedto usage of the network interface module 106, and context informationrelated to a network connection. Within one or more of these contextcategories, context information might include a patient name, apatients' unique hospital identification number, patient location, anidentification number for a network interface module 106, time stampsfor events occurring in the physiological monitoring system 100,environmental conditions such as changes to the state of the network andusage statistics of the network interface module 106, and identificationinformation corresponding to the network link (e.g., whether the networkconnection is WiFi or Ethernet). In one embodiment, the contextinformation in the contextual data package may include all of or anysubset of context information from one or more of the contextcategories. In an embodiment, the context information and measurementinformation are packaged by the virtual machine.

In another embodiment (not shown), end user devices 128, 152 include oneway POCSAG Pagers having a 2 line display with audible and vibrate mode,of suitable size and durability for severe mechanical environmentstypical of hospital general floor settings. In yet another embodiment,the end user devices 128, 152 include two way paging systems, such asMotorola Flex and WLAN pagers. One advantage of two-way paging is theability to confirm message receipt and the ability to remotely silencealarms. Wireless PDAs may also be used by end users based on ruggednessand acceptable form factors as determined by an end user. An example ofsuch a device is the Symbol Technology MC50 PDA/Barcode Scanner.

FIG. 2 depicts another embodiment of a physiological monitoring system200 of the present disclosure. The physiological monitoring system 200(or alternatively other patient care equipment, not shown in FIG. 2)includes network communications enabled devices 210. The networkcommunications enabled devices 210 are connected directly to a hospitalnetwork 220 through a wireless connection. In certain embodiments, thenetwork communications enabled devices 210 include sensors and sensorprocessing modules, similar to the sensors 102 and sensor processingmodules 104 of FIG. 1. Certain of these network communications enableddevices 210 are bedside devices, and others are handheld or otherwisepatient-worn devices that may be used by an ambulatory (mobile) patient.

The hospital network 220 transmits physiological information and contextinformation to clinician notifier devices, including pagers 240, PDAs230 as well as cell phones, portable and stationary computers or anyother communications devices. This information can include informationgenerated by the third party software. In certain embodiments, thehospital network 220 utilizes a server 250 to transmit contextual datapackages to a page transmitter 242, which further transmits the data toone-way wireless pagers 240. An external interface 280 may be coupledwith the server 250. The external interface 280 could include one ormore of the following: enterprise paging, nurse call systems, wide areapaging systems, enterprise clinical and patient information systems, andthird party monitoring and surveillance systems.

FIG. 3 illustrates an embodiment of a pulse oximeter 301. The pulseoximeter 301 includes a display screen 302 which displays variousparameters 303 and 307 along with parameter trends 305 and 309. Thepulse oximeter includes a speaker 314, inputs 311 and sensor 313. In anembodiment, proprietary parameters can be included using third partyproprietary software as described above.

FIG. 4 illustrates an embodiment of a software package selection screen.This display screen can be internal to a monitoring device or can beaccessible via a network, such as a private hospital network or theInternet. In an embodiment, the display screen illustrates the availableproprietary software, along with the price. The price can be based on aper software activation or download or it can be based on a per patientuse.

Those of skill in the art will understand that information and signalscan be represented using any of a variety of different technologies andtechniques. For example, data, instructions, commands, information,signals, bits, symbols, and chips that can be referenced throughout theabove description can be represented by voltages, currents,electromagnetic waves, magnetic fields or particles, optical fields orparticles, or any combination thereof.

Those of skill will further appreciate that the various illustrativelogical blocks, modules, circuits, and algorithm steps described inconnection with the embodiments disclosed herein may be implemented aselectronic hardware, computer software, or combinations of both. Toclearly illustrate this interchangeability of hardware and software,various illustrative components, blocks, modules, circuits, and stepshave been described above generally in terms of their functionality.Whether such functionality is implemented as hardware or softwaredepends upon the particular application and design constraints imposedon the overall system. Skilled artisans can implement the describedfunctionality in varying ways for each particular application, but suchimplementation decisions should not be interpreted as causing adeparture from the scope of the present disclosure.

The various illustrative logical blocks, modules, and circuits describedin connection with the embodiments disclosed herein can be implementedor performed with a general purpose processor, a digital signalprocessor (DSP), an application specific integrated circuit (ASIC), afield programmable gate array (FPGA) or other programmable logic device,discrete gate or transistor logic, discrete hardware components, or anycombination thereof designed to perform the functions described herein.A general purpose processor can be a microprocessor, conventionalprocessor, controller, microcontroller, state machine, etc. A processorcan also be implemented as a combination of computing devices, e.g., acombination of a DSP and a microprocessor, a plurality ofmicroprocessors, one or more microprocessors in conjunction with a DSPcore, or any other such configuration. In addition, the term“processing” is a broad term meant to encompass several meaningsincluding, for example, implementing program code, executinginstructions, manipulating signals, filtering, performing arithmeticoperations, and the like.

The steps of a method or algorithm described in connection with theembodiments disclosed herein can be embodied directly in hardware, in asoftware module executed by a processor, or in a combination of the two.A software module can reside in RAM memory, flash memory, ROM memory,EPROM memory, EEPROM memory, registers, hard disk, a removable disk, aCD-ROM, a DVD, or any other form of storage medium known in the art. Astorage medium is coupled to the processor such that the processor canread information from, and write information to, the storage medium. Inthe alternative, the storage medium may be integral to the processor.The processor and the storage medium can reside in an ASIC. The ASIC canreside in a user terminal. In the alternative, the processor and thestorage medium can reside as discrete components in a user terminal.

The modules can include, but are not limited to, any of the following:software or hardware components such as software object-orientedsoftware components, class components and task components, processes,methods, functions, attributes, procedures, subroutines, segments ofprogram code, drivers, firmware, microcode, circuitry, data, databases,data structures, tables, arrays, or variables.

In addition, although this disclosure has been disclosed in the contextof a certain preferred embodiment, it will be understood by thoseskilled in the art that the present disclosure extends beyond thespecifically disclosed embodiment to other alternative embodimentsand/or uses of the disclosure and obvious modifications and equivalentsthereof. In particular, while the present system and methods have beendescribed in the context of a particularly preferred embodiment, theskilled artisan will appreciate, in view of the present disclosure, thatcertain advantages, features and aspects of the system, device, andmethod may be realized in a variety of other applications and softwaresystems. Additionally, it is contemplated that various aspects andfeatures of the disclosure described can be practiced separately,combined together, or substituted for one another, and that a variety ofcombination and subcombinations of the features and aspects can be madeand still fall within the scope of the disclosure. Furthermore, thesystems described above need not include all of the modules andfunctions described in the preferred embodiments. Thus, it is intendedthat the scope of the present disclosure herein disclosed should not belimited by the particular disclosed embodiment described above, butshould be determined only by a fair reading of the claims that follow.

What is claimed is:
 1. A method of operating third party proprietarysoftware on a medical monitoring device, the method comprising:providing a medical monitoring device, the monitoring device includingoperational software configured to measure and display physiologicalmeasurements using a physiological sensor; downloading onto the medicalmonitoring device third party proprietary software configured to changethe operation of the medical monitoring device; operating the medicalmonitoring device with the third party software.
 2. The method of claim1, wherein the third party proprietary software is downloaded from avirtual software application store.
 3. The method of claim 1, whereinthe third party proprietary software computes a proprietary measurement.4. The method of claim 3, wherein the proprietary measurement isdisplayed on the medical monitoring device.
 5. The method of claim 3,wherein the third party proprietary software is downloaded on a perpatient basis.
 6. The method of claim 3, wherein the third partyproprietary software is downloaded on a per device basis.